QuestionQUESTION: Hello. I am a 36 year old male, former smoker, with Psoriatic arthritis. I had routine x-rays a week ago to determine possible joint damage. A chest x-ray was also performed. I had to re-take the chest x-ray because the Radiologist stated: "No active Pulmonary disease, but there is a questionable small nodular density in left mid-lung field which may be a nipple shadow". I had to wear nipple markers and re-take the chest x-ray. My Internist looked at the x-rays with the nipple markers and said he didn't see anything, and did not think I needed a CT Scan. Is this common? Do I have serious cause for worry? Thank you for your help.
ANSWER: Hi CJ,
Nipple shadows are common and could be misdiagnosed as a pathological nodule. Depending on the experience of the radiologist, many will ignore it as a concerning health problem. Others will use nipple markers on everyone, both male and female, as the markers cost less than $1 per person to ensure a proper reading.
The basic criteria that all physicians use to define the nipple shadow as normal are:
1. they occur on both sides and are symmetric
2. they show a radiolucent "halo" with poorly defined fuzzy margins
3. they are present in the 5th or 6th anterior rib bone of the male and female. In females, it may be present below the shadows of the breast.
4. there should be a comparison with previous chest films to note that there is no changes overtime. If there is a rapid growth, then there is something to be concern about.
5. it could be identified on a lateral chest film.
A true nodular density is a cause for concern of neoplasms (cancers). Since you've had a follow-up x-ray with markers and presumed normal by your physician, then there is no need for concern. An annual mammogram is highly recommended. If your medical insurance approves of sensitive testings, then a breast MRI would be better. However, the cost of a breast MRI is about $800 versus a $75 mammogram.
I highly recommend writing down and addressing any concerns and questions about your results with your physicians to ease your worries.
Regards,
John Thai, MD
---------- FOLLOW-UP ----------
QUESTION: Thank you VERY much for your qucik response! However, I have additional questions. My Internist did read the second set of x-rays (with the nipple markers) BEFORE sending them to the Radiologist. Is it STILL safe to presume my Internist is correct (He said he didn't see anything, and did NOT think I needed a CT Scan). What are the chances my Internist is incorrect and the Radiologist is correct? Also, you suggested that I get an annual Mammogram. Why would a male need a Mammogram? Please forgive the series of questions, but I am somewhat of a worrier, and often times it is not easy to ask a Doctor these questions in person for fear of insulting that Doctor.
AnswerIt is unethical for me to comment on the interpretation made by either your physician or the radiologist. I apologize for not explaining it in detail. A mammogram and/or breast MRI is only necessary if your physician concludes it is a neoplasm. You can always request one if it would ease your worries. But I would like to warn you that not all insurances will approve and/or pay for it.
A CT is not necessary unless your physician feels there is a possible neoplasm in your lungs. CT can only provide either a 32, 64, or 128 sectioned image film on a 2-D level. An MRI is much more useful as it provides a 3-D image of the body and very useful to rule out cancer.
It is normal for you to worry. Thus, I highly recommend that you ask detail questions to your physician until you receive a satisfactory answer.
Regards,
John Thai, MD
